Erica Ms Sibinga

Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis

IMPORTANCE Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. OBJECTIVE To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health-related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. EVIDENCE REVIEW We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. FINDINGS After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). CONCLUSIONS AND RELEVANCE Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.

Why Do Women Use Intimate Partner Violence? A Systematic Review of Women’s Motivations

Studies report that women use as much or more physical intimate partner violence (IPV) as men. Most of these studies measure IPV by counting the number of IPV acts over a specified time period, but counting acts captures only one aspect of this complex phenomenon. To inform interventions, women’s motivations for using IPV must be understood. A systematic review, therefore, was conducted to summarize evidence regarding women’s motivations for the use of physical IPV in heterosexual relationships. Four published literature databases were searched, and articles that met inclusion criteria were abstracted. This was supplemented with a bibliography search and expert consultation. Eligible studies included English-language publications that directly investigated heterosexual women’s motivations for perpetrating nonlethal, physical IPV. Of the 144 potentially eligible articles, 23 met inclusion criteria. Over two thirds of studies enrolled participants from IPV shelters, courts, or batterers’ treatment programs. Women’s motivations were primarily assessed through interviews or administration of an author-created questionnaire. Anger and not being able to get a partner’s attention were pervasive themes. Self-defense and retaliation also were commonly cited motivations, but distinguishing the two was difficult in some studies. Control was mentioned but not listed as a primary motivation. IPV prevention and treatment programs should explore ways to effectively address women’s relationship concerns and ability to manage anger and should recognize that women commonly use IPV in response to their partner’s violence.

School-based mindfulness instruction for urban male youth: A small randomized controlled trial

OBJECTIVES Mindfulness-based stress reduction (MBSR) has been shown to improve mental health and reduce stress in a variety of adult populations. Here, we explore the effects of a school-based MBSR program for young urban males. PARTICIPANTS AND METHODS In fall 2009, 7th and 8th graders at a small school for low-income urban boys were randomly assigned to 12-session programs of MBSR or health education (Healthy Topics-HT). Data were collected at baseline, post-program, and three-month follow-up on psychological functioning; sleep; and salivary cortisol, a physiologic measure of stress. RESULTS Forty-one (22 MBSR and 19 HT) of the 42 eligible boys participated, of whom 95% were African American, with a mean age of 12.5 years. Following the programs, MBSR boys had less anxiety (p=0.01), less rumination (p=0.02), and showed a trend for less negative coping (p=0.06) than HT boys. Comparing baseline with post-program, cortisol levels increased during the academic terms for HT participants at a trend level (p=0.07) but remained constant for MBSR participants (p=0.33). CONCLUSIONS In this study, MBSR participants showed less anxiety, improved coping, and a possible attenuation of cortisol response to academic stress, when compared with HT participants. These results suggest that MBSR improves psychological functioning among urban male youth.

Mindfulness-based stress reduction for HIV-infected youth: a pilot study.

Youth with HIV infection experience stress from many sources, including their health, stigma associated with HIV, and economic concerns. 1 Stress experienced by HIV-positive adolescents can have serious negative consequences on their physical and psychosocial health. Exposure to stress is associated with HIV progression, 2,3 and stress frequently results in maladaptive behavioral responses—poor HIV medication adherence, selfmedication through substance use, risky sexual behavior, and other high-risk behaviors. 4 In adults with HIV, stress reduction programs have been shown to improve behavioral, psychological, and immunologic domains. 5 Mindfulness-based stress reduction (MBSR) as developed by Kabat-Zinn 6 is a structured 8- to 10-week program designed to cultivate focused, nonjudgmental awareness of the present moment. 6 Mindfulness-based stress reduction has been used and studied since 1979 in adult populations with heterogeneous chronic illnesses. Weekly MBSR classes provide instruction in mindfulness techniques, such as mindful meditation, mindful yoga, and the body scan, to enhance participants’ appreciation for moment-to-moment awareness instead of attendingtoworriesaboutthefutureorpast.AlthoughMBSRhasbeen studied widely in adults, we are aware of few published studies of MBSR for youth 7-9 and none in HIV-positive youth. We are interested in investigating the potential benefit of MBSR for urban HIV-infected youth. As a first step, we conducted a pilot study to investigate the feasibility (through enrollment and attendance) and acceptability (through participant interview)ofMBSRinanurbanHIV-infectedyouthpopulation.If MBSR is feasible and acceptable in this population, we will plan a larger randomized trial to evaluate MBSR’s effect on psychological and physical well-being and quality of life.

Perceptions, experiences, and shifts in perspective occurring among urban youth participating in a mindfulness-based stress reduction program

Interest in mindfulness as a tool to improve health and well-being has increased rapidly over the past two decades. Limited qualitative research has been conducted on mindfulness and health. This study utilized in-depth interviews to explore the context, perceptions, and experiences of a sub-set of participants engaged in an acceptability study of mindfulness-based stress reduction (MBSR) among urban youth. Content analysis revealed that all in-depth interview participants reported experiencing some form of positive benefit and enhanced self-awareness as a result of MBSR program participation. Significant variation in the types and intensity of changes occurring was identified, ranging from a reframing and reduction of daily stressors to transformational shifts in life orientation and well-being. Variations in perceptions of and experiences with mindfulness should be studied in further depth in the context of prospective intervention research, including their potentially differential influence on mental and physical health outcomes.

School-based mindfulness instruction: an RCT

BACKGROUND AND OBJECTIVE: Many urban youth experiencesignificant and unremitting negative stressors, including those associated with community violence, multigenerational poverty, failing educational systems, substance use, limited avenues for success, health risks, and trauma. Mindfulness instruction improves psychological functioning in a variety of adult populations; research on mindfulness for youth is promising, but has been conducted in limited populations. Informed by implementation science, we evaluated an adapted mindfulness-based stress reduction (MBSR) program to ameliorate the negative effects of stress and trauma among low-income, minority, middle school public school students. METHODS: Participants were students at two Baltimore City Public Schools who were randomly assigned by grade to receive adapted MBSR or health education (Healthy Topics [HT]) programs. Self-report survey data were collected at baseline and postprogram. Deidentified data were analyzed in the aggregate, comparing MBSR and HT classes, by using regression modeling. RESULTS: Three hundred fifth- to eighth-grade students (mean 12.0 years) were in MBSR and HT classes and provided survey data. Participants were 50.7% female, 99.7% African American, and 99% eligible for free lunch. The groups were comparable at baseline. Postprogram, MBSR students had significantly lower levels of somatization, depression, negative affect, negative coping, rumination, self-hostility, and posttraumatic symptom severity (all Ps < .05) than HT. CONCLUSIONS: These findings support the hypothesis that mindfulness instruction improves psychological functioning and may ameliorate the negative effects of stress and reduce trauma-associated symptoms among vulnerable urban middle school students. Additional research is needed to explore psychological, social, and behavioral outcomes, and mechanisms of mindfulness instruction.

A Small Mixed-Method RCT of Mindfulness Instruction For Urban Youth

OBJECTIVE We aimed to explore the specific effects of mindfulness-based stress reduction (MBSR) for urban youth by comparing it with an active control program, designed to control for time, positive peer-group experience, and positive adult instructor. METHODS Patients between the ages of 13-21 years who received primary pediatric care at our urban outpatient clinic were eligible for study participation. Those who were interested were consented and randomly assigned to an eight-week program of MBSR or Healthy Topics (HT), a health education curriculum. To increase sensitivity to outcomes of interest, mixed methods were used to assess psychological symptoms, coping, and program experience. Analysis of variance and regression modeling were used; interviews were audio-taped, transcribed, and coded for key themes. RESULTS A total of 43 (26 MBSR, 17 HT) youths attended one or more sessions, of whom 35 [20 MBSR (77%), 15 HT (88%)] attended the majority of the sessions and were considered completers. Program completers were African American, 80% female, with average age of 15.0 years. Statistical analysis of survey data did not identify significant post-program differences between groups. Qualitative data show comparable positive experiences in both programs, but specific differences related to MBSR participants׳ use of mindfulness techniques to calm down and avoid conflicts, as well as descriptions of internal processes and self-regulation. CONCLUSIONS Compared with an active control program, MBSR did not result in statistically significant differences in self-reported survey outcomes of interest but was associated with qualitative outcomes of increased calm, conflict avoidance, self-awareness, and self-regulation for urban youths. Importantly, based on qualitative results, the HT program functioned as an effective active control for MBSR in this sample, facilitating a more rigorous methodological approach to MBSR research in this population. We believe the promising effects elucidated in the qualitative data have the potential for positive affective and behavioral outcomes.

Television Viewing by Young Hispanic Children: Evidence of Heterogeneity

OBJECTIVES To determine if hours of daily television viewed by varying age groups of young children with Hispanic mothers differs by maternal language preference and to compare these differences with young children with white mothers. DESIGN Cross-sectional analysis of data collected in 2000 from the National Survey of Early Childhood Health. SETTING Nationally representative sample. PARTICIPANTS One thousand three hundred forty-seven mothers of children aged 4 to 35 months. MAIN EXPOSURE Subgroups of self-reported maternal race/ethnicity (white or Hispanic) and within Hispanic race/ethnicity, stratification by maternal language preference (English or Spanish). OUTCOME MEASURE Hours of daily television the child viewed. RESULTS Bivariate analyses showed that children of English- vs Spanish-speaking Hispanic mothers watched more television daily (1.88 vs 1.31 hours, P < .01). Multivariable regression analyses stratified by age revealed differences by age group. Among 4- to 11-month-old infants, those of English- and Spanish-speaking Hispanic mothers watched similar amounts. However, among children aged 12 to 23 and 24 to 35 months, those of English-speaking Hispanic mothers watched more television than children of Spanish-speaking Hispanic mothers (incidence rate ratio [IRR], 1.61; 95% confidence interval [CI], 1.17-2.22; IRR, 1.66; 95% CI, 1.10-2.51, respectively). Compared with children of white mothers, children of both Hispanic subgroups watched similar amounts among the 4- to 11-month-old group. However, among 12- to 23-month-old children, those of English-speaking Hispanic mothers watched more compared with children of white mothers (IRR, 1.57; 95% CI, 1.18-2.11). Among 24- to 35-month-old children, those of English-speaking Hispanic mothers watched similar amounts compared with children of white mothers, but children of Spanish-speaking Hispanic mothers watched less (IRR, 0.69; 95% CI, 0.50-0.95). CONCLUSION Television-viewing amounts among young children with Hispanic mothers vary by child age and maternal language preference, supporting the need to explore sociocultural factors that influence viewing in Hispanic children.

Complementary, Holistic, and Integrative Medicine: Meditation Practices for Pediatric Health

1. Erica M.S. Sibinga, MD* 2. Kathi J. Kemper, MD, MPH† 1. *Assistant Professor, Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md. 2. †Caryl J. Guth Chair for Holistic and Integrative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. ### Case #1 Maria is a 14-year-old Hispanic girl who has developed chronic headaches and appears to be mildly depressed. She has become irritable and gotten into two fights at school this year. Her aunt, who is raising her, does not want to start her on medication. The aunt has a friend who works as a nurse and recently started a mindfulness-based stress reduction program. Marias aunt wants to know if she could try a similar program. What is the evidence that practicing mindfulness meditation can help someone like Maria? ### Case #2 Antwan is a 12-year-old African American boy in an urban sixth-grade class who has mild hypertension. His teacher is interested in having her students learn some stress management skills to help them focus better in the classroom. She does not want anything inconsistent with her religion, but she has heard that even simple meditation can be helpful. What is the evidence that training in focused attention or concentration-type of meditation can help students like Antwan? ### Case #3 Maggie is a 17-year-old girl who has anorexia nervosa and really wants to keep exercising. Her family physician advised her not to exercise vigorously to avoid further weight loss. Her mother wants to know if yoga can help decrease Maggies anxiety safely. Is yoga safe and effective for teens who have eating disorders? The word “meditation” has the same Indo-European root, “med” (to measure), as the word “medicine”; in Latin, meditation referred to physical or …

Mindfulness-Based Approaches for Children and Youth

Mindfulness meditation is a useful adjunct to behavioral and medical interventions to manage a range of symptoms, including psychological and physical responses to stress, anxiety, depression, and disruptive behavior. Mindfulness approaches can be taught to children, adolescents, and their parents to improve self-regulation, particularly in response to stress. Mindfulness may be particularly relevant for youth and families who have an increased risk for exposure to chronic stress and unique stressors associated with medical and/or social-contextual considerations. Moreover, mindfulness parenting techniques can augment traditional behavioral approaches to improve children׳s behavior through specific parent-child interactions. A growing body of empirical studies and clinical experience suggest that incorporating mindfulness practices will enable clinicians to more effectively treat youth and their families in coping optimally with a range of challenging symptoms.